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Determinants of subclinical diabetic heart disease
Z Y Fang1, R Schull-Meade, M Downey
1University of Queensland, Brisbane, Australia.
Insights
Subclinical left ventricular dysfunction is common in type 2 diabetes. Poor glycemic control, age, and hypertension are key factors, while ACE inhibitors and insulin show protective effects.
Area of Science:
- Cardiology
- Diabetology
- Medical Imaging
Background:
- Subclinical left ventricular (LV) dysfunction is observed in diabetic patients.
- Its prevalence and causes in the absence of coronary disease or LV hypertrophy are not fully understood.
Purpose of the Study:
- To determine the prevalence of subclinical diabetic heart disease.
- To identify the key determinants of this condition.
Main Methods:
- 219 patients with type 2 diabetes underwent echocardiography.
- 120 patients without cardiac disease were assessed using tissue Doppler imaging.
- LV systolic and diastolic function were measured and correlated with clinical, therapeutic, and biochemical variables.
Main Results:
- 27% of diabetic patients exhibited significant subclinical LV dysfunction.
- Systolic dysfunction was linked to higher HbA1c and lack of ACE inhibitor use.
- Diastolic dysfunction was associated with age, hypertension, insulin, and metformin treatment.
Conclusions:
- Subclinical LV dysfunction is prevalent in diabetes mellitus.
- It is associated with poor glycemic control, age, and hypertension.
- ACE inhibitors and insulin therapy may offer cardioprotection.
Aims/Hypothesis:
Subclinical left ventricular (LV) dysfunction has been shown by tissue Doppler and strain imaging in diabetic patients in the absence of coronary disease or LV hypertrophy, but the prevalence and aetiology of this finding remain unclear. This study sought to identify the prevalence and the determinants of subclinical diabetic heart disease.
Methods:
A group of 219 unselected patients with type 2 diabetes without known cardiac disease underwent resting and stress echocardiography. After exclusion of coronary artery disease or LV hypertrophy, the remaining 120 patients (age 57+/-10 years, 73 male) were studied with tissue Doppler imaging. Peak systolic strain of each wall and systolic (Sm) and diastolic (Em) velocity of each basal segment were measured from the three apical views and averaged for each patient. Significant subclinical LV dysfunction was identified according to Sm and Em normal ranges adjusted by age and sex. Strain and Em were correlated with clinical, therapeutic, echocardiographic and biochemical variables, and significant independent associations were sought using a multiple linear regression model.
Results:
Significant subclinical LV dysfunction was present in 27% diabetic patients. Myocardial systolic dysfunction by peak strain was independently associated with glycosylated haemoglobin level (p<0.001) and lack of angiotensin-converting enzyme inhibitor treatment (p=0.003). Myocardial diastolic function (Em) was independently predicted by age (p=0.013), hypertension (p=0.001), insulin (p=0.008) and metformin (p=0.01) treatment.
Conclusions/Interpretation:
In patients with diabetes mellitus, subclinical LV dysfunction is common and associated with poor diabetic control, advancing age, hypertension and metformin treatment; ACE inhibitor and insulin therapies appear to be protective.
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